Date: December 29, 2017
To: Hospitals, Physicians, Advanced Practice Nurses
Re: Expansion of Abortion Reimbursement Effective January 1, 2018
Pursuant to Public Act 100-0538 the Department of Healthcare and Family Services (HFS) will expand coverage of legal abortion services for eligible persons in the Medical Assistance Program. Prior to January 1, 2018, HFS reimbursed abortion services performed for the following reasons: when the woman's life is endangered; to end pregnancies resulting from rape or incest; or if necessary to protect a woman's health. For dates of service on or after January 1, 2018, HFS will reimburse abortion services for the following reasons: when the woman's life is endangered; to end pregnancies resulting from rape or incest; if necessary to protect a woman's health; and for any other reason. HFS will continue to reimburse for surgical abortions or abortions resulting from the administration of a medication.
· Practitioner services must be billed with the appropriate CPT code along with one of the modifiers specified below. Abortion services billed without a modifier will be rejected.
o Modifier U4 (Pregnancy Resulting from Rape)
o Modifier U7 (Pregnancy Resulting from Incest)
o Modifier U8 (Pregnancy is Threatening the Mother’s Life)
o Modifier U9 (Pregnancy Endangers the Mother’s Health
o Modifier SE (Abortion Performed for Other Reason)
· Hospital services must be billed with the abortion “AH” condition code.
· A copy of the form HFS 2390, Abortion Payment Application, must accompany claims for the services.
· Providers must provide a statement on form HFS 2390 that states the abortion was performed for reasons other than those listed on the form. Form HFS 2390 is being revised to allow an option for an “Other” selection for providers and will be issued by the Department in the near future.
· Providers seeking reimbursement for abortion services rendered to participants enrolled in HealthChoice Illinois when the woman's life is endangered, to end pregnancies resulting from rape or incest, or if necessary to protect a woman's health, must be billed to the HealthChoice Illinois managed care plan. Providers seeking reimbursement for abortion services for any other reason rendered to participants enrolled in HealthChoice Illinois must be billed directly to HFS as a fee-for-service claim and not to the HealthChoice Illinois managed care plan.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services or Bureau of Hospital and Provider Services at 877-782-5565.
Felicia F. Norwood